Tong Xu, Wang Yilong, Bauer Clayton T, Jia Baixue, Zhang Xuelei, Huo Xiaochuan, Luo Gang, Wang Anxin, Ma Ning, Gao Feng, Mo Dapeng, Song Ligang, Sun Xuan, Liu Lian, Deng Yiming, Li Xiaoqing, Wang Bo, Ma Gaoting, Wang Yongjun, Ren Zeguang, Miao Zhongrong
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ther Adv Neurol Disord. 2021 Apr 12;14:17562864211007715. doi: 10.1177/17562864211007715. eCollection 2021.
Although noninferior to stent retriever (SR) as first-line approach for endovascular treatment (EVT) of acute large vessel occlusion (LVO) stroke, little is known about the current status of direct aspiration (DA) as first-line thrombectomy in China. This analysis of a prospective, nationwide registry (ANGEL-ACT) aimed to investigate the prevalence and comparative effectiveness of DA-first thrombectomy in a real-world practice in China.
All patients receiving thrombectomy were screened from a prospective cohort of LVO patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and divided into two groups based upon which type of thrombectomy was attempted first ("DA-first" and "SR-first"). The following outcome measures were compared using logistic regression models with adjustment: successful recanalization after first-device alone and all procedures, use of rescue treatment, intracranial hemorrhage (ICH) within 24 h, and modified Rankin Scale (mRS) score at 90 days.
A total of 1225 patients, 102 (8.3%) in DA-first group and 1123 (91.7%) in SR-first group, were included. Patients receiving DA-first had less often successful recanalization after first-device alone [30.4 66.4%; odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.15-0.37], more frequent rescue treatment (62.8 27.0%; OR = 4.55, 95% CI = 2.92-7.08) and ICH (35.4 22.1%; OR = 1.78, 95% CI = 1.12-2.83) than those receiving SR-first; however, no significant difference was found in successful recanalization after all procedures (84.3 90.3%; = 0.18) and 90-day mRS (median: 3 3 points; = 0.90) between both groups.
This real-world registry suggested that DA-first thrombectomy for acute stroke patients lagged behind in China during the study period. Far fewer DA-first than SR-first thrombectomies were performed, and DA-first was associated with lower first-device recanalization, more frequently requiring rescue treatment, and increased ICH risk.
ClinicalTrials.gov, NCT03370939.
尽管在急性大血管闭塞（LVO）性卒中的血管内治疗（EVT）中，作为一线治疗方法，直接抽吸（DA）并不逊色于支架取栓器（SR），但在中国，关于DA作为一线血栓切除术的现状知之甚少。这项对一项前瞻性全国性注册研究（ANGEL-ACT）的分析旨在调查在中国真实临床实践中，先行DA血栓切除术的患病率及相对有效性。
对2017年11月至2019年3月期间在中国111家医院接受EVT的LVO患者前瞻性队列中所有接受血栓切除术的患者进行筛选，并根据首次尝试的血栓切除术类型分为两组（“先行DA组”和“先行SR组”）。使用经调整的逻辑回归模型比较以下结局指标：仅首次器械操作及所有操作后的成功再通情况、挽救治疗的使用、24小时内颅内出血（ICH）以及90天时的改良Rankin量表（mRS）评分。
共纳入1225例患者，其中先行DA组102例（8.3%），先行SR组1123例（91.7%）。先行DA组患者仅首次器械操作后的成功再通率较低[30.4%对66.4%；比值比（OR）=0.23，95%置信区间（CI）=0.15 - 0.37]，挽救治疗更频繁（62.8%对27.0%；OR = 4.55，95% CI = 2.92 - 7.08），ICH发生率更高（35.4%对22.1%；OR = 1.78，95% CI = 1.12 - 2.83）；然而，两组在所有操作后的成功再通率（84.3%对90.3%；P = 0.18）及90天mRS评分（中位数：3分对3分；P = 0.90）方面无显著差异。
这项真实临床实践注册研究表明，在研究期间，中国急性卒中患者先行DA血栓切除术相对滞后。先行DA血栓切除术的病例数远少于先行SR血栓切除术，且先行DA与首次器械再通率较低、更频繁需要挽救治疗以及ICH风险增加相关。
ClinicalTrials.gov，NCT03370939
